By Lisa Zeigel
Earlier this year a national pollster conducted a phone survey of 1,000 individuals to get an idea of how this selected population viewed the importance of exercise. From this sampling, 75 percent stated that they agreed that exercise is “somewhat” important in daily life, inclusive of 33 percent who took the view that it is “very important.” In 2009, another poll found 39 percent of respondents subscribing to the belief that Americans will need to change their lifestyles (by becoming more physically active) in order to lower health care costs.
It is no wonder that for the most part people understand the importance of exercise. There is a growing presence in our daily lives of reminders of how we need to exercise for health and to avoid disease: Through supermarkets (the Ralph’s grocery store chain’s website has an entire fitness section alongside the food ads and coupons), many morning news shows with daily exercise or fitness-related segments, newspapers with fitness sections and a growing number of health and fitness magazines that seem to be exploding on the newsstands.
But – - we know that despite all of this, the majority of Americans are still not getting the minimum amount of physical activity needed to reap all of the health gains, and particularly the disease-preventative benefits. If people know and understand about its importance to their own well-being, why aren’t they doing it? There is an organization within the American College of Sports Medicine (ACSM) that is making a dedicated effort to close this gap between awareness and action. This group is called “Exercise is Medicine” (EIM), and members are reaching out to a specific group of people who can help make this happen – the medical profession. Their initiative is to educate physicians and health-care providers to make physical activity part of their standard care and to consider each patient’s activity level (or lack of) as a “vital sign” just as they would their blood pressure, heart rate and body temperature. The hope is that once a patient is given a specific “prescription” for exercise instead of simply a suggestion this guidance will encourage participation in activity, thus increasing the chances that the need for costly medical care can be lessened or even eliminated. This alliance is led by a team of 17, which includes distinguished Fellows of the ACSM, physicians and sports medicine researchers, and leaders in the health and fitness field (including the U.S. Surgeon General). One of their goals is to partner with not only health-care providers, but to also enlist support from leaders on every continent in all settings, including government, cities and communities, recreation areas, schools and in the workplace.
The EIM team has worked hard to develop tools that can be utilized by these targeted groups to enable a better understanding of how exercise can be considered as a powerful alternative to costly drugs or other interventions, as well as methods of relaying this to patients and helping them to understand the same. In the past as a trainer I would encounter clients who would tell me that his or her doctor had ordered them to exercise but were given very little guidance on how to get started or where to go. In addition, it was also up to me to sit down with my trainee to go over their health history, find out about any physical limitations or conditions and to learn about what medications they might be taking that might affect their exercise performance. Normally, the person would not know anything about the medications they were taking or how, if they had a condition like diabetes, arthritis, asthma, etc., this would affect them while exercising. Often, I would have to obtain a medical consent from their caregiver to ensure the safety of the individual. EIM would like to improve this situation by developing a better partnership between physicians and fitness professionals so that a trainer would be able to read a prescription for exercise from a doctor just as a pharmacist would with a prescription for blood pressure medication. In addition, the clients would be pre-screened for their readiness for exercise, saving time so that the trainer can spend more quality time with their charge.
Prescribing exercise as medicine would benefit physicians by cutting back on the time they spend on repeat visits from patients with conditions, since many have such a high patient load that it becomes difficult to provide efficient and timely care. (If you have ever sat in a waiting room for more than an hour to be seen after your scheduled appointment time, you will appreciate this.) And, of course, the fitness provider would benefit as the proposed “Prescription for Exercise” form also includes a referral to a health and exercise professional. Gyms, private trainers, YMCAs, etc., can all market their services to be included in a referral list. Providers of specialties, such as yoga, Pilates and aquatic exercise are able to make themselves part of this. Health-care providers, such as PPOs and HMOs, are now beginning to maintain their own in-house staff of trainers, class instructors and more; members may be referred to them as part of their health-care coverage.
The EIM has created an action guide for health professionals to help them integrate an exercise history and a physical activity readiness questionnaire (PARQ) into the standard initial patient visit. There is even a guideline to help determine the patient’s level of psychological readiness to participate in activity and steps to address those who are not quite ready to embrace it, as well as helping others who are to move forward. But the EIM is not stopping there. The group is also proposing that training in physical activity prescription be part of the curriculum in medical schools so that these tools can be ingrained in the physician’s standard of care from the beginning. Before they do that, they should be incorporating it into their own daily lives. Like the adage “physician heal thyself,” another motto that could apply would be “practice what you preach.” Doctors and caregivers should strive to get the activity they themselves need to stay healthy before prescribing it to their patients!
And finally, as we all know, not everyone is fortunate enough to have adequate health-care coverage. EIM has developed an extensive network consisting of organizations, such as the Commonwealth Fund and the National Rural Health Association, dedicated to reaching out to low-income, under-insured populations and getting the concept out to them, as well as influencing policy-making on Capitol Hill for the advancement of exercise for health for all.
You can see that the EIM team is an impressive force setting out on an ambitious task. Its members are the best in their fields, and their dedication is unwavering. Their mission statement/guiding principles are simple:
- Exercise and physical activity are important to health and the prevention and treatment of many chronic diseases.
- More should be done to address physical activity and exercise in health-care settings.
- Multi-organizational efforts to bring a greater focus on physical activity and exercise in health-care settings are encouraged.
And their scope is broad. I have heard people say that they wish they could put exercise in a pill, because there is nearly no condition or malady that exercise cannot make better. Maybe that pill will never be invented, but a prescription for activity is the next best thing. Visit www.exerciseismedicine.org to learn more.